President-elect Trump’s choice of very conservative Republican South Carolina Congressman Mick Mulvaney to head the Office of Management and Budget is further indication that Mr. Trump and Republican leaders will indeed seek to kill the Affordable Care Act — and probably mostly succeed.

As director of the OMB, Rep. Mulvaney will probably want to cut Medicare and Medicaid spending through privatization via providing many Medicare members with “premium support” with which they’d pay for private insurance to replace their Medicare and giving block grants to the states to help pay for Medicaid. Such more limited federal funding will likely mean big cuts in healthcare for the poor.

“I have voted many times to repeal [the ACA] and I will continue to work toward repealing that law and replacing it with solutions that work for everyone,” Mr. Mulvaney writes on his Web site.

“Obamacare has created an environment where most people can afford to buy health insurance but can’t afford to go to the doctor because of very high deductibles. This ‘solution’ has created more problems than it has solved and we need to repeal it and start over.”

He helped found the House Freedom Caucus, a group of conservatives, that has issued a report outlining recommended policies to be announced during Mr. Trump’s first 100 days. More than 50 affect healthcare.

The recommendations include such granular details as removing HHS restrictions on sunlamps {which cause cancer}, to changing the physician-fee schedule, to killing a rule mandating that some preventive health services be covered by employer-sponsored health insurance.